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Zhang K, Stricker P, Löhr M, Stehling M, Suberville M, Cussenot O, Lunelli L, Ng CF, Teoh J, Laguna P, de la Rosette J. A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00783-y. [PMID: 38195916 DOI: 10.1038/s41391-023-00783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/08/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Irreversible electroporation (IRE) is a novel technique to treat localized prostate cancer with the aim of achieving oncological control while reducing related side effects. We present the outcomes of localized prostate cancer treated with IRE from a multi-center prospective registry. METHODS Men with histologically confirmed prostate cancer were recruited to receive IRE. All the patients were proposed for prostate biopsy at 1-year post-IRE ablation. The functional outcomes were measured by the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. The safety of IRE was graded by the treatment-related adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE). RESULTS 411 patients were recruited in this study from July 2015 to April 2020. The median follow-up time was 24 months (IQR 15-36). 116 patients underwent repeat prostate biopsy during 12-18 months after IRE. Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 24.1% (28/116) of the patients; any grade prostate cancers were found in 59.5% (69/116) of the patients. The IPSS score increased significantly from 7.1 to 8.2 (p = 0.015) at 3 months but decreased to 6.1 at 6 months (p = 0.017). Afterwards, the IPSS level remained stable during follow-up. The IIEF-5 score decreased at 3 months from 16.0 to 12.1 (p < 0.001) and then maintained equable afterwards. The rate of AEs was 1.8% at 3 months and then dropped to less than 1% at 6 months and remained stable until 48 months after IRE. Major AEs (Grade 3 or above) were rare. CONCLUSION For men with localized prostate cancer, IRE could achieve good urinary and sexual function outcomes and a reasonable oncological result. The real-world data are consistent with earlier studies, including recently published randomized controlled studies. The long-term oncological results need further investigation and follow-up.
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Affiliation(s)
- Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Phillip Stricker
- Department of Urology, St Vincents Private Hospital Sydney, St Vincents Prostate Cancer Research Centre and The Garvan Institute, Sydney, Australia
| | - Martin Löhr
- Department of Urology, Klinik für Prostata-Therapie, Heidelberg, Germany
| | - Michael Stehling
- VITUS Privatklinik and Institut für Bildgebende Diagnostik, Strahlenbergerstrasse, Offenbach, Germany
| | - Michel Suberville
- Doctor Michel SUBERVILLE Chief of Pôle, Pôle SAINT GERMAIN - CENTRE HOSPITALIER, Brive la Gaillarde, France
| | | | - Luca Lunelli
- Department of Urology, Hospital Louis Pasteur, Chartres, France
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Pilar Laguna
- Department of Urology, Medipol Mega hospital, Istanbul Medipol University, Istanbul, Türkiye
| | - Jean de la Rosette
- Department of Urology, Medipol Mega hospital, Istanbul Medipol University, Istanbul, Türkiye.
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Shin D, Yoon CE, Kwon HJ, Moon HW, Park YH, Cho HJ, Ha US, Hong SH, Park SY, Ha S, Hyun O J, Yoo IR, Park C, Chi DY, Lee JY. Irreversible electroporation for prostate cancer using PSMA PET-CT. Prostate Int 2023; 11:40-45. [PMID: 36910902 PMCID: PMC9995691 DOI: 10.1016/j.prnil.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022] Open
Abstract
Background To demonstrate the clinical usefulness of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computerized tomography (CT) for irreversible electroporation (IRE) in prostate cancer patients. Methods From January to May 2021, 17 men were diagnosed with localized prostate cancer through preoperative mpMRI and [18F] florastamin PSMA PET-CT imaging, followed by transperineal MRI-ultrasound fusion-guided biopsy. The patients underwent IRE focal therapy at the target lesions under general anesthesia. To evaluate the treatment outcome, serum prostate-specific antigen (PSA) levels were followed up in the 1st, 3rd, 6th, 9th, 12th months, and mpMRI was taken in the 1st and 12th months, followed by MR fusion biopsy in the 12th month post-IRE. Results The mean age of the patients was 66.1 ± 9.3 with a median PSA of 7.5 ng/ml. After the treatment, PSA nadir was 4.06 ± 3.4, and 11 (64.7%) achieved decline of PSA more than 50% from the baseline. Rate of negative biopsy for prostate cancer is 88% (15/17) at 12 months MR fusion biopsy after the IRE treatment. Among the relapsed cases, 1 (6.9%) patient recurred at margin of treated area, and 1 (6.9%) patient was from outfield recurrence. When excluding initial four patients, none of the patients had cancer recur. Conclusions When treating with IRE focal therapy, PSMA-PET CT is a potentially valuable diagnostic approach for localizing prostate cancer; it supports the detection of lesions with conventional mpMRI, enabling to perform the procedure more completely.
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Affiliation(s)
- Dongho Shin
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Eil Yoon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeok Jae Kwon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sonya Youngju Park
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seunggyun Ha
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun O
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ie Ryung Yoo
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chansoo Park
- Research Institute of Labelling, FutureChem Co., Ltd, Seoul, Korea
| | - Dae Yoon Chi
- Research Institute of Labelling, FutureChem Co., Ltd, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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O'Neill CH, Martin RCG. Cardiac synchronization and arrhythmia during irreversible electroporation. J Surg Oncol 2020; 122:407-411. [PMID: 32483842 DOI: 10.1002/jso.26041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Irreversible electroporation (IRE) is a nonthermal electrical tumor ablative strategy for unresectable tumors. IRE is relatively safe around critical structures but may induce cardiac arrhythmia when its delivery is not synchronized to the cardiac cycle. We performed a systematic literature review to determine rates of arrhythmia when IRE was utilized with or without cardiac synchronization. METHODS An online literature search was conducted with additional hand selection of articles. Data were extracted and pooled analyses were performed. RESULTS Twelve articles were included in analysis. IRE was performed for 481 patients; 46% hepatic tumors (n = 223), 36% pancreatic lesions (n = 168), and multiple other locations including prostate. Synchronization was performed on 422 patients. Arrhythmias were noted in 3.7% of cases (n = 18/481); cardiac synchronization: 1.2% (n = 5/422) vs unsynchronized: 22.0% (n = 13/59), P < .0001. These events occurred in every organ except the prostate. CONCLUSIONS IRE remains a potent technology for unresectable tumors, but arrhythmia is a clinical concern. This literature review confirms that cardiac gating should be used in all cases outside of prostate to prevent this potentially serious adverse event.
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Affiliation(s)
- Conor H O'Neill
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
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Abstract
Prostate cancer is the fifth leading cause of death worldwide. A variety of treatment options is available for localized prostate cancer and may range from active surveillance to focal therapy or whole gland treatment, that is, surgery or radiotherapy. Serum prostate-specific antigen levels are an important tool to monitor treatment success after whole gland treatment, unfortunately prostate-specific antigen is unreliable after focal therapy. Multiparametric magnetic resonance imaging of the prostate is rapidly gaining field in the management of prostate cancer and may play a crucial role in the evaluation of recurrent prostate cancer. This article will focus on postprocedural magnetic resonance imaging after different forms of local therapy in patients with prostate cancer.
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Abstract
Interventional therapies are emerging modalities for the treatment of localized prostate cancer. Their aim is to reduce the morbidity associated with radical therapies (rT) by minimizing damage to non-cancerous tissue, with priority given to sparing key structures such as the neurovascular bundles, external sphincter, bladder neck, and rectum, while maintaining local cancer control. Interventional ablative technologies deliver energy in different ways to destroy cancer cells. The most widely investigated techniques are brachytherapy, external beam radiotherapy, cryotherapy, and high-intensity focused ultrasound. Although functional outcomes of focal therapies have been encouraging, with generally low rates of urinary incontinence and erectile dysfunction, robust medium- and long-term oncological outcomes are not available for all techniques. To date, major controversies in focal therapy concern appropriate patient selection, efficacy of focal therapies, as well as treatment paradigms based on the dominant index lesion hypothesis. This review articles discusses the current status of interventional therapies and the oncological and functional outcomes.
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Scheltema MJ, O'Brien TJ, van den Bos W, de Bruin DM, Davalos RV, van den Geld CWM, Laguna MP, Neal RE, Varkarakis IM, Skolarikos A, Stricker PD, de Reijke TM, Arena CB, de la Rosette J. Numerical simulation modeling of the irreversible electroporation treatment zone for focal therapy of prostate cancer, correlation with whole-mount pathology and T2-weighted MRI sequences. Ther Adv Urol 2019; 11:1756287219852305. [PMID: 31217820 PMCID: PMC6557022 DOI: 10.1177/1756287219852305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background: At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE. Methods: In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient. Results: A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383–750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386–580 V/cm) when the ablation zone volumes were used from the follow-up MRI. Conclusions: The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.
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Affiliation(s)
- Matthijs J Scheltema
- Department of Urology, Amsterdam UMC, Meibergdreef 9, Room G4-249, Amsterdam, 1105 AZ, The Netherlands
| | - Tim J O'Brien
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | | | | | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Cees W M van den Geld
- Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maria P Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert E Neal
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Ioannis M Varkarakis
- Second Urology Department, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Andreas Skolarikos
- Second Urology Department, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Phillip D Stricker
- Department of Urology, St. Vincent's Prostate Cancer Centre, Sydney, Australia
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Christopher B Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey Amsterdam UMC, Amsterdam, the Netherlands
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Rubin AE, Usta OB, Schloss R, Yarmush M, Golberg A. Selective Inactivation of Pseudomonas aeruginosa and Staphylococcus epidermidis with Pulsed Electric Fields and Antibiotics. Adv Wound Care (New Rochelle) 2019; 8:136-148. [PMID: 31737412 DOI: 10.1089/wound.2018.0819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/15/2018] [Indexed: 01/17/2023] Open
Abstract
Objective: Increasing numbers of multidrug-resistant bacteria make many antibiotics ineffective; therefore, new approaches to combat microbial infections are needed. In addition, antibiotics are not selective-they kill pathogenic organisms as well as organisms that could positively contribute to wound healing (bio flora). Approach: Here we report on selective inactivation of Pseudomonas aeruginosa and Staphylococcus epidermidis, potential pathogens involved in wound infections with pulsed electric fields (PEFs) and antibiotics (mix of penicillin, streptomycin, and nystatin). Results: Using a Taguchi experimental design in vitro, we found that, under similar electric field strengths, the pulse duration is the most important parameter for P. aeruginosa inactivation, followed by the number of pulses and pulse frequency. P. aeruginosa, a potential severe pathogen, is more sensitive than the less pathogenic S. epidermidis to PEF (alone or in combination with antibiotics). Applying 200 pulses with a duration of 60 μs at 2.8 Hz, the minimum electric fields of 308.8 ± 28.3 and 378.4 ± 12.9 V/mm were required to inactive P. aeruginosa and S. epidermidis, respectively. Addition of antibiotics reduced the threshold for minimum electric fields required to inactivate the bacteria. Innovation: This study provides essential information, such as critical electric field parameters for bacteria inactivation, required for developing in vivo treatment and clinical protocols for using PEF for wound healing. Conclusion: A combination of PEFs with antibiotics reduces the electric field threshold required for bacteria disinfection. Such an approach simplifies devices required to disinfect large areas of infected wounds.
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Affiliation(s)
- Andrey Ethan Rubin
- Porter School of Environment and Earth Sciences, Tel Aviv University Ramat Aviv, Tel Aviv, Israel
| | - Osman Berk Usta
- Center for Engineering in Medicine, Massachusetts General Hospital Shriners Burn Hospital for Children and Harvard Medical School, Boston, Massachusetts
| | - Rene Schloss
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Martin Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital Shriners Burn Hospital for Children and Harvard Medical School, Boston, Massachusetts
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Alexander Golberg
- Porter School of Environment and Earth Sciences, Tel Aviv University Ramat Aviv, Tel Aviv, Israel
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Livia C, Sugrue A, Witt T, Polkinghorne MD, Maor E, Kapa S, Lehmann HI, DeSimone CV, Behfar A, Asirvatham SJ, McLeod CJ. Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability. J Am Heart Assoc 2018; 7:e009070. [PMID: 30371233 PMCID: PMC6201470 DOI: 10.1161/jaha.118.009070] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022]
Abstract
Background The Purkinje network appears to play a pivotal role in the triggering as well as maintenance of ventricular fibrillation. Irreversible electroporation ( IRE ) using direct current has shown promise as a nonthermal ablation modality in the heart, but its ability to target and ablate the Purkinje tissue is undefined. Our aim was to investigate the potential for selective ablation of Purkinje/fascicular fibers using IRE . Methods and Results In an ex vivo Langendorff model of canine heart (n=8), direct current was delivered in a unipolar manner at various dosages from 750 to 2500 V, in 10 pulses with a 90-μs duration at a frequency of 1 Hz. The window of ventricular fibrillation vulnerability was assessed before and after delivery of electroporation energy using a shock on T-wave method. IRE consistently eradicated all Purkinje potentials at voltages between 750 and 2500 V (minimum field strength of 250-833 V/cm). The ventricular electrogram amplitude was only minimally reduced by ablation: 0.6±2.3 mV ( P=0.03). In 4 hearts after IRE delivery, ventricular fibrillation could not be reinduced. At baseline, the lower limit of vulnerability to ventricular fibrillation was 1.8±0.4 J, and the upper limit of vulnerability was 19.5±3.0 J. The window of vulnerability was 17.8±2.9 J. Delivery of electroporation energy significantly reduced the window of vulnerability to 5.7±2.9 J ( P=0.0003), with a postablation lower limit of vulnerability=7.3±2.63 J, and the upper limit of vulnerability=18.8±5.2 J. Conclusions Our study highlights that Purkinje tissue can be ablated with IRE without any evidence of underlying myocardial damage.
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Affiliation(s)
- Christopher Livia
- Department of Cardiovascular Medicine and Department of Molecular Pharmacology and Experimental TherapeuticsCenter for Regenerative MedicineMayo ClinicRochesterMN
| | - Alan Sugrue
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
| | - Tyra Witt
- Department of Cardiovascular Medicine and Department of Molecular Pharmacology and Experimental TherapeuticsCenter for Regenerative MedicineMayo ClinicRochesterMN
| | - Murray D. Polkinghorne
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
| | - Elad Maor
- Leviev Heart Center, Sheba Medical CenterSackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Suraj Kapa
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
| | - Helge I. Lehmann
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
| | - Christopher V. DeSimone
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
| | - Atta Behfar
- Department of Cardiovascular Medicine and Department of Molecular Pharmacology and Experimental TherapeuticsCenter for Regenerative MedicineMayo ClinicRochesterMN
| | - Samuel J. Asirvatham
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
- Division of Pediatric CardiologyDepartment of Pediatric and Adolescent MedicineMayo ClinicRochesterMN
| | - Christopher J. McLeod
- Division of Heart Rhythm ServicesDepartment of Cardiovascular DiseasesMayo ClinicRochesterMN
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Muller BG, van Kollenburg RAA, Swaan A, Zwartkruis ECH, Brandt MJ, Wilk LS, Almasian M, Schreurs AW, Faber DJ, Rozendaal LR, Vis AN, Nieuwenhuijzen JA, van Moorselaar JRJA, de la Rosette JJMCH, de Bruin DM, van Leeuwen TG. Needle-based optical coherence tomography for the detection of prostate cancer: a visual and quantitative analysis in 20 patients. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-11. [PMID: 30094972 DOI: 10.1117/1.jbo.23.8.086001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/18/2018] [Indexed: 05/08/2023]
Abstract
Diagnostic accuracy of needle-based optical coherence tomography (OCT) for prostate cancer detection by visual and quantitative analysis is defined. 106 three-dimensional (3-D)-OCT data sets were acquired in 20 prostates after radical prostatectomy and precisely matched with pathology. OCT images were grouped per histological category. Two reviewers performed blind assessments of the OCT images. Sensitivity and specificity for malignancy detection were calculated. Quantitative analyses by automated optical attenuation coefficient calculation were performed. OCT can reliably differentiate between fat, cystic, and regular atrophy and benign glands. The overall sensitivity and specificity for malignancy detection was 79% and 88% for reviewer 1 and 88% and 81% for reviewer 2. Quantitative analysis for differentiation between stroma and malignancy showed a significant difference (4.6 mm - 1 versus 5.0 mm - 1 Mann-Whitney U-test p < 0.0001). A Kruskal-Wallis test showed a significant difference in median attenuation coefficient between stroma, inflammation, Gleason 3, and Gleason 4 (4.6, 4.1, 5.9, and 5.0 mm - 1, respectively). However, attenuation coefficient varied per patient and a related-samples Wilcoxon signed-rank test showed no significant difference per patient (p = 0.17). This study confirmed the one to one correlation of histopathology and OCT. Precise matching showed that most histological tissues categories in the prostate could be distinguished by their unique pattern in OCT images. In addition, the optical attenuation coefficient can play a role in the differentiation between stroma and malignancy; however, a per patient analysis of the optical attenuation coefficient did not show a significant difference.
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Affiliation(s)
- Berrend G Muller
- University of Amsterdam, Academic Medical Center, Department of Urology, The Netherlands
| | - Rob A A van Kollenburg
- University of Amsterdam, Academic Medical Center, Department of Urology, The Netherlands
| | - Abel Swaan
- University of Amsterdam, Academic Medical Center, Department of Urology, The Netherlands
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
| | - Evita C H Zwartkruis
- VU University Medical Center, Department of Pathology, Amsterdam, The Netherlands
| | - Martin J Brandt
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
| | - Leah S Wilk
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
| | - Mitra Almasian
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
| | - A Wim Schreurs
- University of Amsterdam, Academic Medical Center, Department of Instrumental Services, The Netherlands
| | - Dirk J Faber
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
| | - L Rence Rozendaal
- VU University Medical Center, Department of Pathology, Amsterdam, The Netherlands
| | - Andre N Vis
- VU University Medical Center, Department of Urology, Amsterdam, The Netherlands
| | | | | | - Jean J M C H de la Rosette
- University of Amsterdam, Academic Medical Center, Department of Urology, The Netherlands
- Istanbul Medipol University, Department of Urology, Istanbul, Turkey
| | - Daniel Martijn de Bruin
- University of Amsterdam, Academic Medical Center, Department of Urology, The Netherlands
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
| | - Ton G van Leeuwen
- University of Amsterdam, Academic Medical Center, Department of Biomedical Engineering and Physics, The Netherlands
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Calio B, Kasson M, Sugano D, Ortman M, Gaitonde K, Verma S, Sidana A. Multiparametric MRI: An Opportunity for Focal Therapy of Prostate Cancer. Semin Roentgenol 2018; 53:227-233. [DOI: 10.1053/j.ro.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Sano MB, DeWitt MR, Teeter SD, Xing L. Optimization of a single insertion electrode array for the creation of clinically relevant ablations using high-frequency irreversible electroporation. Comput Biol Med 2018; 95:107-117. [DOI: 10.1016/j.compbiomed.2018.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 12/18/2022]
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Pesapane F, Patella F, Fumarola EM, Zanchetta E, Floridi C, Carrafiello G, Standaert C. The prostate cancer focal therapy. Gland Surg 2018; 7:89-102. [PMID: 29770305 PMCID: PMC5938267 DOI: 10.21037/gs.2017.11.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.
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Affiliation(s)
- Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Edoardo Zanchetta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Chiara Floridi
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Chloë Standaert
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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Chinenov DV, Rapoport LM, Shpot EV, Enikeev DV, Chernov YN, Taratkin MS, Korolev DO. Comparative results of cryoablation and laparoscopic radical prostatectomy in the treatment of localized prostate cancer. Urologia 2018; 85:68-72. [PMID: 30043713 DOI: 10.1177/0391560317749425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To evaluate early prostate cancer cryoablation functional and oncological results in comparison with results of extraperitoneoscopic radical prostatectomy. MATERIALS AND METHODS We analyzed early results of surgical treatment of 285 patients with prostate cancer: 42 of them had undergone total cryoablation (Group 1) while the rest of them had been treated by radical laparo- and extraperitoneoscopic prostatectomy. For comparative assessment of prostate cryoablation results, 42 patients from Group 2 randomized in accordance with their age, stage of disease, Gleason, prostate-specific antigen, and prostate volume were selected. In compliance with the results of pre-surgical examination, all the patients had low oncological risk and were not concerned in sexual function. Volume of prostate was from 22 to 65 cm3, prostate-specific antigen level was from 4.1 to 10 ng/mL, and level of neoplastic process differentiation using Gleason grading system was from 6 to 7a (3 + 4) scores. RESULTS Patients after prostate cryoablation in early post-surgical period felt lower intensity of postoperative pain compared with those who had undergone prostatectomy. Follow-up period up to 12 months manifested significant true reduction of prostate-specific antigen level in both groups of patients. Frequency of stress-induced enuresis in Group 1 was not observed. CONCLUSION Radical prostatectomy is still the traditional treatment of choice in the case of localized prostate cancer. But we can draw the conclusion that cryoablation is an effective low-invasive method for treatment of low oncological risk patients, which gives the opportunity both to achieve good oncological results and to preserve high life quality.
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15
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Scheltema MJ, Postema AW, de Bruin DM, Buijs M, Engelbrecht MR, Laguna MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. Irreversible electroporation for the treatment of localized prostate cancer: a summary of imaging findings and treatment feedback. Diagn Interv Radiol 2018; 23:365-370. [PMID: 28830850 DOI: 10.5152/dir.2017.16608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Imaging plays a crucial role in ablative therapies for prostate cancer (PCa). Irreversible electroporation (IRE) is a new treatment modality used for focal treatment of PCa. We aimed to demonstrate what imaging modalities can be used by descriptively reporting contrast-enhanced ultrasonography (CEUS), multiparametric magnetic resonance imaging (mpMRI), and grey-scale transrectal ultrasound (TRUS) results. Furthermore, we aimed to correlate quantitatively the ablation zone seen on mpMRI and CEUS with treatment planning to provide therapy feedback. METHODS Imaging data was obtained from two prospective multicenter trials on IRE for localized low- to intermediate-risk PCa. The ablation zone volume (AZV) seen on mpMRI and CEUS was 3D reconstructed to correlate with the planned AZV. RESULTS Descriptive examples are provided using mpMRI, TRUS, and CEUS for treatment planning and follow-up after IRE. The mean AZV on T2-weighted imaging 4 weeks following IRE was 12.9 cm3 (standard deviation [SD]=7.0), 5.3 times larger than the planned AZV. Linear regression showed a positive correlation (r=0.76, P = 0.002). For CEUS the mean AZV was 20.7 cm3 (SD=8.7), 8.5 times larger than the planned AZV with a strong positive correlation (r=0.93, P = 0.001). Prostate volume is reduced over time (mean= -27.5%, SD=11.9%) due to ablation zone fibrosis and deformation, illustrated by 3D reconstruction. CONCLUSION The role of imaging in conjunction with IRE is of crucial importance to guide clinicians throughout the treatment protocol. CEUS and mpMRI may provide essential treatment feedback by visualizing the ablation zone dimensions and volume.
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16
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Baur ADJ, Collettini F, Enders J, Maxeiner A, Schreiter V, Stephan C, Gebauer B, Hamm B, Fischer T. MRI-TRUS fusion for electrode positioning during irreversible electroporation for treatment of prostate cancer. Diagn Interv Radiol 2018; 23:321-325. [PMID: 28508759 DOI: 10.5152/dir.2017.16276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to introduce an approach for image-guided positioning of electrodes for irreversible electroporation (IRE) in patients with prostate cancer using a magnetic resonance imaging-transrectal ultrasonography (MRI-TRUS) fusion technique. In 10 consecutive patients with biopsy-proven Gleason score ≤3+4 prostate cancer, 19 G electrodes were inserted into the prostate using a transperineal access. Magnetic resonance images of the prostate acquired before IRE were fused with transrectal ultrasound images acquired during IRE. The position of the ultrasound probe was tracked via a sensor and corresponding magnetic resonance images were calculated in real-time. While MRI allowed delineation of the target volume, the position of the electrodes could be visualized on ultrasound images; the distance between individual electrode pairs was measured. Based on these measurements the software installed on the IRE unit was able to calculate the voltage necessary to generate the electric field for ablation. Using contrast-enhanced ultrasound, changes in perfusion within the ablation zone after IRE were documented. This technique allowed positioning of the electrodes around the target volume under image guidance in all patients treated with IRE. The target lesion and a safety margin were covered within the estimated ablation zone. MRI-TRUS guidance for IRE combines the advantages of good visualization of the target lesion on MRI with the ability of ultrasound to acquire imaging in real-time with a mobile device.
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Affiliation(s)
- Alexander D J Baur
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Dong S, Wang H, Zhao Y, Sun Y, Yao C. First Human Trial of High-Frequency Irreversible Electroporation Therapy for Prostate Cancer. Technol Cancer Res Treat 2018; 17:1533033818789692. [PMID: 30045668 PMCID: PMC6071159 DOI: 10.1177/1533033818789692] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/10/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022] Open
Abstract
Irreversible electroporation, as a nonthermal therapy of prostate cancer, has been used in clinic for several years. The mechanism of irreversible electroporation ablation is thermal independent; thus, the main structures (eg, rectum, urethra, and neurovascular bundle) in prostate are spared during the treatment, which leads to the retention of prostate function. However, various clinical trials have shown that muscle contractions occur during this therapy, which warrants deep muscle anesthesia. Use of high-frequency bipolar pulses has been proposed to reduce muscle contractions during treatment, which has already triggered a multitude of studies at the cellular and animal scale. In this study, we first investigated the efficacy and safety of high-frequency bipolar pulses in human prostate cancer ablation. There are 40 male patients with prostate cancer aged between 51 and 85 years involved in this study. All patients received 250 high-frequency bipolar pulse bursts with the repeat frequency of 1 Hz. Each burst comprised 20 individual pulses of 5 microseconds, so one burst total energized time was 100 microseconds. The number of the electrodes ranged 2 to 6, depending on tumor size. A small amount of muscle relaxant was still needed, so there were no visible muscle contractions during the pulse delivery process. Four weeks after treatment, it was found that the ablation margins were distinct in magnetic resonance imaging scans, and the prostate capsule and urethra were retained. Eight patients underwent radical prostatectomy for pathological analysis after treatment, and the results of hematoxylin and eosin staining revealed that the urethra and major vasculature in prostate have been preserved. By overlaying the electric field contour on the ablation zone, the electric field lethality threshold is determined to be 522 ± 74 V/cm. This study is the first to validate the feasibility of tumor ablation by high-frequency bipolar pulses and provide valuable experience of irreversible electroporation in clinical applications.
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Affiliation(s)
- Shoulong Dong
- State Key Laboratory of Power Transmission Equipment & System Security
and New Technology, Chongqing University, Chongqing, People’s Republic of China
| | - Haifeng Wang
- Department of Urology, Shanghai Changhai Hospital, Shanghai, People’s
Republic of China
| | - Yajun Zhao
- State Key Laboratory of Power Transmission Equipment & System Security
and New Technology, Chongqing University, Chongqing, People’s Republic of China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Shanghai, People’s
Republic of China
| | - Chenguo Yao
- State Key Laboratory of Power Transmission Equipment & System Security
and New Technology, Chongqing University, Chongqing, People’s Republic of China
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18
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The Safety of Irreversible Electroporation on Nerves Adjacent to Treated Tumors. World Neurosurg 2017; 108:642-649. [DOI: 10.1016/j.wneu.2017.09.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 12/18/2022]
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19
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Pañella C, Castellví Q, Moll X, Quesada R, Villanueva A, Iglesias M, Naranjo D, Sánchez-Velázquez P, Andaluz A, Grande L, Ivorra A, Burdío F. Focused Transhepatic Electroporation Mediated by Hypersaline Infusion through the Portal Vein in Rat Model. Preliminary Results on Differential Conductivity. Radiol Oncol 2017; 51:415-421. [PMID: 29333120 PMCID: PMC5765318 DOI: 10.1515/raon-2017-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/22/2017] [Indexed: 12/18/2022] Open
Abstract
Background Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion. Material and methods Sprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed. HI was performed (NaCl 20%, 3.8 mL/Kg) by trans-splenic puncture. Deionized serum (40 mL/Kg) and furosemide (2 mL/Kg) were simultaneously infused through the jugular vein to compensate hypernatremia. Changes in conductivity were monitored in the hepatic and tumour tissue. The period in which hepatic conductivity was higher than tumour conductivity was defined as the therapeutic window (TW). Animals were monitored during 1-month follow-up. The animals were sacrificed and selective samples were used for histological analysis. Results The overall survival rate was 82.4% after the HI protocol. The mean maximum hepatic conductivity after HI was 2.7 and 3.5 times higher than the baseline value, in group A and B, respectively. The mean maximum hepatic conductivity after HI was 1.4 times higher than tumour tissue in group B creating a TW to implement selective IRE. Conclusions HI through the portal vein is safe when the hypersaline overload is compensated with deionized serum and it may provide a TW for focused IRE treatment on tumour nodules.
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Affiliation(s)
- Clara Pañella
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Quim Castellví
- Department of Informatics and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Moll
- Department of Pathological Anatomy, Hospital del Mar Medical Research Insitute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Rita Quesada
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Alberto Villanueva
- Chemoresistance and Predictive Factors Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Mar Iglesias
- Medical and Surgery Animal Department, Faculty of Veterinary, Universitat Autònoma de Barcelona, Cerdanyola del VallèsBarcelona, Spain
| | - Dolores Naranjo
- Medical and Surgery Animal Department, Faculty of Veterinary, Universitat Autònoma de Barcelona, Cerdanyola del VallèsBarcelona, Spain
| | - Patricia Sánchez-Velázquez
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Andaluz
- Department of Pathological Anatomy, Hospital del Mar Medical Research Insitute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Luís Grande
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antoni Ivorra
- Department of Informatics and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Fernando Burdío
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
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20
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Campelo S, Valerio M, Ahmed HU, Hu Y, Arena SL, Neal RE, Emberton M, Arena CB. An evaluation of irreversible electroporation thresholds in human prostate cancer and potential correlations to physiological measurements. APL Bioeng 2017; 1:016101. [PMID: 31069281 PMCID: PMC6481690 DOI: 10.1063/1.5005828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022] Open
Abstract
Irreversible electroporation (IRE) is an emerging cancer treatment that utilizes non-thermal electric pulses for tumor ablation. The pulses are delivered through minimally invasive needle electrodes inserted into the target tissue and lead to cell death through the creation of nanoscale membrane defects. IRE has been shown to be safe and effective when performed on tumors in the brain, liver, kidneys, pancreas, and prostate that are located near critical blood vessels and nerves. Accurate treatment planning and prediction of the ablation volume require a priori knowledge of the tissue-specific electric field threshold for cell death. This study addresses the challenge of defining an electric field threshold for human prostate cancer tissue. Three-dimensional reconstructions of the ablation volumes were created from one week post-treatment magnetic resonance imaging (MRIs) of ten patients who completed a clinical trial. The ablation volumes were incorporated into a finite element modeling software that was used to simulate patient-specific treatments, and the electric field threshold was calculated by matching the ablation volume to the field contour encompassing the equivalent volume. Solutions were obtained for static tissue electrical properties and dynamic properties that accounted for electroporation. According to the dynamic model, the electric field threshold was 506 ± 66 V/cm. Additionally, a potentially strong correlation (r = −0.624) was discovered between the electric field threshold and pre-treatment prostate-specific antigen levels, which needs to be validated in higher enrollment studies. Taken together, these findings can be used to guide the development of future IRE protocols.
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Affiliation(s)
- Sabrina Campelo
- Laboratory for Therapeutic Directed Energy, Department of Physics, Elon University, Elon, North Carolina 27244, USA
| | | | | | - Yipeng Hu
- Centre for Medical Image Computing, University College London, London WC1E 6BT, United Kingdom
| | | | - Robert E Neal
- AngioDynamics, Marlborough, Massachusetts 01752, USA
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21
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Abstract
The target of focal therapy (FT) in prostate cancer (PC) is partial treatment of the prostate aiming at preserving surrounding anatomical structures. The intention is to minimize typical side effects of radical treatment options combined with local tumor control. Numerous established and new technologies are used. Results of published studies showed a good safety profile, few side effects and good preservation of functional results. Oncologic long-term data are lacking so far. Photodynamic therapy (PDT) is the only technology that has been studied in a published prospective randomized trial. The FT is challenged by the multifocality of PC; therefore, the quality of prostate biopsy, histopathological assessment as well as imaging are of paramount importance. Multiparametric magnetic resonance imaging (MRI) has gained increasing importance. The FT is experimental and should only be offered within clinical trials.
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22
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Ivey JW, Latouche EL, Richards ML, Lesser GJ, Debinski W, Davalos RV, Verbridge SS. Enhancing Irreversible Electroporation by Manipulating Cellular Biophysics with a Molecular Adjuvant. Biophys J 2017; 113:472-480. [PMID: 28746857 DOI: 10.1016/j.bpj.2017.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022] Open
Abstract
Pulsed electric fields applied to cells have been used as an invaluable research tool to enhance delivery of genes or other intracellular cargo, as well as for tumor treatment via electrochemotherapy or tissue ablation. These processes involve the buildup of charge across the cell membrane, with subsequent alteration of transmembrane potential that is a function of cell biophysics and geometry. For traditional electroporation parameters, larger cells experience a greater degree of membrane potential alteration. However, we have recently demonstrated that the nuclear/cytoplasm ratio (NCR), rather than cell size, is a key predictor of response for cells treated with high-frequency irreversible electroporation (IRE). In this study, we leverage a targeted molecular therapy, ephrinA1, known to markedly collapse the cytoplasm of cells expressing the EphA2 receptor, to investigate how biophysical cellular changes resulting from NCR manipulation affect the response to IRE at varying frequencies. We present evidence that the increase in the NCR mitigates the cell death response to conventional electroporation pulsed-electric fields (∼100 μs), consistent with the previously noted size dependence. However, this same molecular treatment enhanced the cell death response to high-frequency electric fields (∼1 μs). This finding demonstrates the importance of considering cellular biophysics and frequency-dependent effects in developing electroporation protocols, and our approach provides, to our knowledge, a novel and direct experimental methodology to quantify the relationship between cell morphology, pulse frequency, and electroporation response. Finally, this novel, to our knowledge, combinatorial approach may provide a paradigm to enhance in vivo tumor ablation through a molecular manipulation of cellular morphology before IRE application.
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Affiliation(s)
- Jill W Ivey
- Laboratory for Integrative Tumor Ecology, Virginia Tech-Wake Forest University School of Biomedical Engineering & Sciences, Blacksburg, Virginia
| | - Eduardo L Latouche
- Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University School of Biomedical Engineering & Sciences, Blacksburg, Virginia
| | - Megan L Richards
- Laboratory for Integrative Tumor Ecology, Virginia Tech-Wake Forest University School of Biomedical Engineering & Sciences, Blacksburg, Virginia
| | - Glenn J Lesser
- Brain Tumor Center of Excellence, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Waldemar Debinski
- Brain Tumor Center of Excellence, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Rafael V Davalos
- Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University School of Biomedical Engineering & Sciences, Blacksburg, Virginia; Brain Tumor Center of Excellence, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Scott S Verbridge
- Laboratory for Integrative Tumor Ecology, Virginia Tech-Wake Forest University School of Biomedical Engineering & Sciences, Blacksburg, Virginia; Brain Tumor Center of Excellence, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
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Abstract
With the advent of focal therapy as a recognized treatment option for men with prostate cancer, there are a host of emerging interventions that take advantage of MRI for image guidance. Focal therapy affords a middleground option for patients with low- to intermediate-grade prostate cancer by providing a means of keeping their cancer at bay while avoiding the negative consequences of radical therapies. However, the practice of focal treatment is far from straightforward, with some believing focal treatment errs on the side of overtreatment among patients with low-grade cancer; others worry it is undertreatment in potentially significant multifocal disease. Further research is necessary, both relating to focal therapy in general and to the utility of each MRI-guided focal treatment discussed.
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Affiliation(s)
- Melvy Sarah Mathew
- Abdominal & Pelvic Imaging Section, Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Aytekin Oto
- Abdominal & Pelvic Imaging Section, Department of Radiology, University of Chicago, Chicago, IL, USA
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24
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Patel P, Oto A. Magnetic Resonance Imaging of the Prostate, Including Pre- and Postinterventions. Semin Intervent Radiol 2016; 33:186-95. [PMID: 27582606 DOI: 10.1055/s-0036-1586144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article systematically reviews the rationale for magnetic resonance imaging in prostate cancer, in detection and following various treatment methods. A basic discussion of the identification of prostate cancer is imperative to understand postintervention imaging. Each available therapy, including surgery, radiation, hormone therapy, and focal therapies will be discussed along with associated imaging findings, providing the reader with a better understanding of current interventions in prostate cancer and imaging.
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Affiliation(s)
- Pritesh Patel
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Aytekin Oto
- Department of Radiology, University of Chicago, Chicago, Illinois
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25
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van den Bos W, Jurhill R, de Bruin D, Savci-Heijink C, Postema A, Wagstaff P, Muller B, Varkarakis I, Skolarikos A, Zondervan P, Laguna Pes M, de Reijke T, de la Rosette J. Histopathological Outcomes after Irreversible Electroporation for Prostate Cancer: Results of an Ablate and Resect Study. J Urol 2016; 196:552-9. [PMID: 27004693 DOI: 10.1016/j.juro.2016.02.2977] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 12/18/2022]
Affiliation(s)
- W. van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R.R. Jurhill
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - D.M. de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - C.D. Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A.W. Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - P.G.K. Wagstaff
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - B.G. Muller
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - I.M. Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A. Skolarikos
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - P.J. Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M.P. Laguna Pes
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - T.M. de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J.J.M.C.H. de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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26
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van den Bos W, de Bruin DM, van Randen A, Engelbrecht MRW, Postema AW, Muller BG, Varkarakis IM, Skolarikos A, Savci-Heijink CD, Jurhill RR, Zondervan PJ, Laguna Pes MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. MRI and contrast-enhanced ultrasound imaging for evaluation of focal irreversible electroporation treatment: results from a phase I-II study in patients undergoing IRE followed by radical prostatectomy. Eur Radiol 2016; 26:2252-60. [PMID: 26449559 PMCID: PMC4902838 DOI: 10.1007/s00330-015-4042-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Irreversible electroporation (IRE) is an ablative therapy with a low side-effect profile in prostate cancer. The objective was: 1) To compare the volumetric IRE ablation zone on grey-scale transrectal ultrasound (TRUS), contrast-enhanced ultrasound (CEUS) and multiparametric MRI (mpMRI) with histopathology findings; 2) To determine a reliable imaging modality to visualize the IRE ablation effects accurately. METHODS A prospective phase I-II study was performed in 16 patients scheduled for radical prostatectomy (RP). IRE of the prostate was performed 4 weeks before RP. Prior to, and 4 weeks after the IRE treatment, imaging was performed by TRUS, CEUS, and mpMRI. 3D-analysis of the ablation volumes on imaging and on H&E-stained whole-mount sections was performed. The volumes were compared and the correlation was calculated. RESULTS Evaluation of the imaging demonstrated that with T2-weighted MRI, dynamic contrast enhanced (DCE) MRI, and CEUS, effects of IRE are visible. T2MRI and CEUS closely match the volumes on histopathology (Pearson correlation r = 0.88 resp. 0.80). However, IRE is not visible with TRUS. CONCLUSIONS mpMRI and CEUS are appropriate for assessing IRE effects and are the most feasible imaging modalities to visualize IRE ablation zone. The imaging is concordant with results of histopathological examination. KEY POINTS • mpMRI and contrast-enhanced ultrasound are appropriate imaging modalities for assessing IRE effects • mpMRI and CEUS are the most feasible imaging modalities to visualize IRE ablation zone • The imaging is concordant with results of histopathological examination after IRE • Grey-scale US is insufficient for assessing IRE ablations.
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Affiliation(s)
- Willemien van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - D M de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A van Randen
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M R W Engelbrecht
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A W Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - B G Muller
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - I M Varkarakis
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, 1 Sismanogliou Street, 151 26, Marousi, Greece
| | - A Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, 1 Sismanogliou Street, 151 26, Marousi, Greece
| | - C D Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R R Jurhill
- Department of Pathology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P Laguna Pes
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - H Wijkstra
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - T M de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J M C H de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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27
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van den Bos W, de Bruin DM, Jurhill RR, Savci-Heijink CD, Muller BG, Varkarakis IM, Skolarikos A, Zondervan PJ, Laguna-Pes MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. The correlation between the electrode configuration and histopathology of irreversible electroporation ablations in prostate cancer patients. World J Urol 2016; 34:657-64. [PMID: 26296371 PMCID: PMC4841841 DOI: 10.1007/s00345-015-1661-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/30/2015] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Irreversible electroporation (IRE) is a novel minimally invasive therapy for prostate cancer using short electric pulses to ablate prostate tissue. The purpose of this study is to determine the IRE effects in prostate tissue and correlate electrode configuration with the histology of radical prostatectomy (RP) specimens. We hypothesize that the area within the electrode configuration is completely ablated and that the area within the electrode configuration is predictive for the ablated area after treatment. METHODS A prospective phase I/II study was conducted in 16 consecutive patients with histopathologically confirmed prostate cancer scheduled for RP. Focal or extended IRE treatment of the prostate was performed 4 weeks prior to RP. The locations of the electrodes were used to calculate the planned ablation zone. Following RP, the specimens were processed into whole-mount sections, histopathology (PA) was assessed and ablation zones were delineated. The area of the tissue alteration was determined by measuring the surface. The planned and the histological ablation zones were compared, analysed per individual patient and per protocol (focal vs. extended). RESULTS All cells within the electrode configuration were completely ablated and consisted only of necrotic and fibrotic tissue without leaving any viable cells. The histological ablation zone was always larger than the electrodes configuration (2.9 times larger for the 3 electrodes configuration and 2.5 times larger for the ≥4 electrode configuration). These ablation effects extended beyond the prostatic capsule in the neurovascular bundle in 13 out of 15 cases. CONCLUSIONS IRE in prostate cancer results in completely ablated, sharply demarcated lesions with a histological ablation zone beyond the electrode configuration. No skip lesions were observed within the electrode configuration. CLINICAL TRIALS ClinicalTrials.gov Identifier: NCT01790451 https://clinicaltrials.gov/ct2/show/NCT01790451.
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Affiliation(s)
- W van den Bos
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - D M de Bruin
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics. Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R R Jurhill
- Department of Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C D Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B G Muller
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A Skolarikos
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - P J Zondervan
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Laguna-Pes
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H Wijkstra
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - T M de Reijke
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J M C H de la Rosette
- Department of Urology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ultrasound validation of mathematically modeled irreversible electroporation ablation areas. Surgery 2016; 159:1032-40. [DOI: 10.1016/j.surg.2015.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/06/2015] [Accepted: 10/28/2015] [Indexed: 12/18/2022]
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Thermal Energy during Irreversible Electroporation and the Influence of Different Ablation Parameters. J Vasc Interv Radiol 2016; 27:433-43. [DOI: 10.1016/j.jvir.2015.10.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/22/2015] [Accepted: 10/23/2015] [Indexed: 12/18/2022] Open
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Postema AW, De Reijke TM, Ukimura O, Van den Bos W, Azzouzi AR, Barret E, Baumunk D, Blana A, Bossi A, Brausi M, Coleman JA, Crouzet S, Dominguez-Escrig J, Eggener S, Ganzer R, Ghai S, Gill IS, Gupta RT, Henkel TO, Hohenfellner M, Jones JS, Kahmann F, Kastner C, Köhrmann KU, Kovacs G, Miano R, van Moorselaar RJ, Mottet N, Osorio L, Pieters BR, Polascik TJ, Rastinehad AR, Salomon G, Sanchez-Salas R, Schostak M, Sentker L, Tay KJ, Varkarakis IM, Villers A, Walz J, De la Rosette JJ. Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project. World J Urol 2016; 34:1373-82. [PMID: 26892160 PMCID: PMC5026990 DOI: 10.1007/s00345-016-1782-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.
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Affiliation(s)
- A W Postema
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.
| | - T M De Reijke
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - O Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - W Van den Bos
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - A R Azzouzi
- Department of Urology, Angers University Hospital, Angers, France
| | - E Barret
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - D Baumunk
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - A Blana
- Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Brausi
- Department of Urology, Ospedale Civile Ramazzini, Carpi, Italy
| | - J A Coleman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - J Dominguez-Escrig
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - R Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - S Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - I S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R T Gupta
- Departments of Radiology, Duke University Medical Center, Durham, NC, USA
| | - T O Henkel
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - J S Jones
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cancer Directorate, Cambridge University Hospitals Trust, Cambridge, UK
| | - K U Köhrmann
- Department of Urology, Theresien Krankenhaus Mannheim, Mannheim, Germany
| | - G Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany
| | - R Miano
- Division of Urology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - R J van Moorselaar
- Department of Urology, Free University Medical Centre, Amsterdam, The Netherlands
| | - N Mottet
- Department of Urology, University Hospital St Etienne, Saint-Étienne, France
| | - L Osorio
- Department of Urology, Porto Hospital Centre, Porto, Portugal
| | - B R Pieters
- Departments of Radiation Oncology, AMC University Hospital, Amsterdam, The Netherlands
| | - T J Polascik
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A R Rastinehad
- Department of Urology, Hofstra North Shore-Lij, Hofstra University, Hempstead, NY, USA
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - R Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - M Schostak
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - L Sentker
- Urologische Gemeinschaftspraxis, Sinsheim, Germany
| | - K J Tay
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - J J De la Rosette
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
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Wendler JJ, Fischbach K, Ricke J, Jürgens J, Fischbach F, Köllermann J, Porsch M, Baumunk D, Schostak M, Liehr UB, Pech M. Irreversible Electroporation (IRE): Standardization of Terminology and Reporting Criteria for Analysis and Comparison. Pol J Radiol 2016; 81:54-64. [PMID: 26966472 PMCID: PMC4760650 DOI: 10.12659/pjr.896034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Irreversible electroporation (IRE) as newer ablation modality has been introduced and its clinical niche is under investigation. At present just one IRE system has been approved for clinical use and is currently commercially available (NanoKnife® system). In 2014, the International Working Group on Image-Guided Tumor Ablation updated the recommendation about standardization of terms and reporting criteria for image-guided tumor ablation. The IRE method is not covered in detail. But the non-thermal IRE method and the NanoKnife System differ fundamentally from established ablations techniques, especially thermal approaches, e.g. radio frequency ablation (RFA). MATERIAL/METHODS As numerous publications on IRE with varying terminology exist so far - with numbers continuously increasing - standardized terms and reporting criteria of IRE are needed urgently. The use of standardized terminology may then allow for a better inter-study comparison of the methodology applied as well as results achieved. RESULTS Thus, the main objective of this document is to supplement the updated recommendation for image-guided tumor ablation by outlining a standardized set of terminology for the IRE procedure with the NanoKnife Sytem as well as address essential clinical and technical informations that should be provided when reporting on IRE tumor ablation. CONCLUSIONS We emphasize that the usage of all above recommended reporting criteria and terms can make IRE ablation reports comparable and provide treatment transparency to assess the current value of IRE and provide further development.
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Affiliation(s)
- Johann J Wendler
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | | | - Jens Ricke
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Julian Jürgens
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Jens Köllermann
- Department of Pathology, Sana Klinikum Offenbach a. M., Offenbach Am Main, Germany
| | - Markus Porsch
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Daniel Baumunk
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Martin Schostak
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
| | - Uwe-Bernd Liehr
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology, University of Magdeburg, Magdeburg, Germany
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Kuru TH, van Essen J, Pfister D, Porres D. Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer. Oncol Res Treat 2015; 38:634-8. [DOI: 10.1159/000441600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/09/2015] [Indexed: 11/19/2022]
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Ting F, Tran M, Böhm M, Siriwardana A, Van Leeuwen PJ, Haynes AM, Delprado W, Shnier R, Stricker PD. Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control. Prostate Cancer Prostatic Dis 2015; 19:46-52. [PMID: 26458959 DOI: 10.1038/pcan.2015.47] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/25/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current data on the use of irreversible electroporation (IRE) in the treatment of prostate cancer (PCa) is limited. We aim to evaluate the safety, short-term functional and oncological outcomes of focal IRE in low-intermediate risk PCa. METHODS Between February 2013 and May 2014, 32 consecutive men underwent IRE at a single centre. Patients with low-intermediate risk PCa who had not received previous PCa treatment were included for analysis. The tumour was ablated using 3-6 electrodes, ensuring a minimum 5-mm safety margin around the visible magnetic resonance imaging (MRI) lesion. Follow-up included recording Clavien complications, Expanded Prostate Cancer Index Composite (EPIC) questionnaires (baseline, 1.5, 3, 6 months), 6-month multi-parametric MRI (mp-MRI) and 7-month biopsy. Findings on mp-MRI and biopsy were sub-divided into infield, adjacent or outfield of the treatment zone. RESULTS Twenty-five men were included for final analysis. Safety follow-up revealed one Clavien Grade 3 complication and five Grade 1 complications. Functional follow-up confirmed no significant change in American Urological Association urinary symptom score, sexual or bowel function. Infield, there were no suspicious findings on mp-MRI (n=24) or biopsy (n=21) in all patients. Adjacent to the treatment zone, five (21%) had suspicious findings on mp-MRI with four (19%) proving to be significant on biopsy. Outfield, there were two (8%) with suspicious findings on mp-MRI and one (5%) significant finding on biopsy. For the five patients with significant findings on follow-up biopsy, one is awaiting repeat IRE, one had radical prostatectomy and three remained on active surveillance. CONCLUSIONS In selected patients with low-intermediate risk PCa, focal IRE appears to be safe with minimal morbidity. There were no infield recurrences and 76% of patients were histologically free of significant cancer at 8 months. Almost all recurrences were adjacent to the treatment zone, and this was addressed by widening the treatment margins.
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Affiliation(s)
- F Ting
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - M Tran
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - M Böhm
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - A Siriwardana
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - P J Van Leeuwen
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - A M Haynes
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - W Delprado
- Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - R Shnier
- Southern Radiology, Randwick, NSW, Australia
| | - P D Stricker
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
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Tschon M, Salamanna F, Ronchetti M, Cavani F, Gasbarrini A, Boriani S, Fini M. Feasibility of Electroporation in Bone and in the Surrounding Clinically Relevant Structures: A Preclinical Investigation. Technol Cancer Res Treat 2015; 15:737-748. [PMID: 26351303 DOI: 10.1177/1533034615604454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/14/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022] Open
Abstract
Skeletal metastases are a common cause of severe morbidity, reduction in quality of life and often early mortality. Consequently, improvements in therapies are necessary. Electroporation uses electric energy to alter cancer cell membrane permeability and enhance the local uptake of chemotherapeutics, thus leading to local tumor control. The aim of this study was to investigate the feasibility and safety of delivering electric field protocols causing electroporation of healthy bone and structures of clinical relevance using small and large animal models. Reversible electroporation was used in the rabbit sciatic nerve by applying 2 series of 8 pulses 100ms long at 1000 V/cm. Irreversible electroporation was used in rabbit distal femur condyles and in sheep vertebral body by applying 120 pulses 100ms long at 1750 V/cm. Any effect on surrounding sensitive structures was investigated. Reversible electroporation of sciatic nerve was associated with transient foot functional deficit that completely recovered at 30 days. Irreversible electroporation removed cells from trabeculae in the femurs of rabbits and in the vertebral body of sheep. After irreversible protocol, histology and microtomography demonstrated that the trabecular structure was maintained, the presence of new bone marrow cells, osteoblasts, and mineral apposition characterized by new trabeculae thinner than controls (P = .005) and a significant reduction in the ablated areas (-225%, P = .0219). Spinal cord, vertebral pedicles and spinal nerves showed transient edema in the absence of functional or structural alterations. Collectively, these results show that electroporation can be safely applied to bone even in the proximity of neuronal structures.
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Affiliation(s)
- Matilde Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy .,Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Francesca Salamanna
- Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli, Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Francesco Cavani
- Department of Biomedical, Metabolic and Neural Sciences, Section of Human Morphology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Gasbarrini
- Spine Surgery prevalently Oncologic and Degenerative, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Boriani
- Spine Surgery prevalently Oncologic and Degenerative, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy.,Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli, Rizzoli Orthopaedic Institute, Bologna, Italy
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Stern JM, Kibanov Solomonov VV, Sazykina E, Schwartz JA, Gad SC, Goodrich GP. Initial Evaluation of the Safety of Nanoshell-Directed Photothermal Therapy in the Treatment of Prostate Disease. Int J Toxicol 2015; 35:38-46. [DOI: 10.1177/1091581815600170] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To evaluate the clinical safety profile for the use of gold nanoshells in patients with human prostate cancer. This follows on the nonclinical safety assessment of the AuroShell particles reported previously. Twenty-two patients, with biopsy diagnosed prostate cancer, underwent nanoshell infusion and subsequent radical prostatectomy (RRP). Fifteen of these patients had prostates that were additionally irradiated by a single-fiber laser ablation in each prostate hemisphere prior to RRP. Patients in the study were assessed at 9 time points through 6 months postinfusion. Adverse events were recorded as reported by the patients and from clinical observation. Blood and urine samples were collected at each patient visit and subjected to chemical (16 tests), hematological (23 tests), immunological (3 tests, including total PSA), and urinalysis (8 tests) evaluation. Temperature of the anterior rectal wall at the level of the prostate was measured. The study, recorded 2 adverse events that were judged attributable to the nanoparticle infusion: (1) an allergic reaction resulting in itching, which resolved with intravenous antihistamines, and (2) in a separate patient, a transient burning sensation in the epigastrium. blood/hematology/urinalysis assays indicated no device-related changes. No change in temperature of the anterior rectal wall was recorded in any of the patients. The clinical safety profile of AuroShell particles is excellent, matching nonclinical findings. A recent consensus statement suggested that the published literature does not support a preference for any ablation technique over another.1 Now that clinical safety has been confirmed, treatment efficacy of the combined infusion plus laser ablation in prostate will be evaluated in future studies using imaging modalities directing the laser against identified prostate tumors.
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Affiliation(s)
- Joshua M. Stern
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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van den Bos W, de la Rosette J. RANDOMIZED CONTROLLED TRIAL ON IRREVERSIBLE ELECTROPORATION FOR LOCALIZED PROSTATE CANCER:FOCAL ABLATION VERSUS EXTENDED ABLATION. J Endourol 2015; 29:851-4. [PMID: 26274021 DOI: 10.1089/end.2015.29001.vdb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Belfiore MP, Ronza FM, Romano F, Ianniello GP, De Lucia G, Gallo C, Marsicano C, Di Gennaro TL, Belfiore G. Percutaneous CT-guided irreversible electroporation followed by chemotherapy as a novel neoadjuvant protocol in locally advanced pancreatic cancer: Our preliminary experience. Int J Surg 2015; 21 Suppl 1:S34-9. [PMID: 26118600 DOI: 10.1016/j.ijsu.2015.06.049] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC). METHODS We performed CT-guided percutaneous IRE in 20 patients with LAPC, followed by a combination of gemcitabine (1000 mg/mq) and oxaliplatin (100 mg/mq) biweekly. Imaging follow-up was performed by a contrast enhanced CT scan at 1, 3, 6 months and then every 3 months. RESULTS No major complications occurred. Two patients died 3 and 4 months after IRE because of rapidly progressive disease. In the remaining 18 patients 6-month imaging follow-up showed a mean lesions volumetric decrease percentage of 42.89% (95% Confidence Interval: 34.90-54.88%). Thanks to lesions downstaging, three patients underwent R0 resection. At last available follow-up (mean follow-up 91 months; range 6-14), imaging showed no disease progression or post-surgical relapse in all 18 cases. The mean estimated survival was 12,950 months (95% CI: 11,570-14,332). CONCLUSIONS Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.
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Affiliation(s)
- Maria Paola Belfiore
- Department of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara" Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy.
| | - Francesco Michele Ronza
- Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Francesco Romano
- Department of Informatics, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy
| | | | - Guido De Lucia
- Department of Oncology, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Concetta Gallo
- Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Carmela Marsicano
- Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Teresa Letizia Di Gennaro
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy
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What tumours should we treat with focal therapy based on risk category, grade, size and location? Curr Opin Urol 2015; 25:212-9. [PMID: 25844714 DOI: 10.1097/mou.0000000000000170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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